title: Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control.
abstract: OBJECTIVE
  To test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.
  
  
  METHODS
  A total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA(1c). Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA(1c) and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.
  
  
  RESULTS
  A significant difference in HbA(1c) change between the groups was observed at 4 months (intervention -0.88 [-1.15 to -0.60] versus control -0.35 [-0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention -0.46 [-0.77 to -0.13] versus control -0.20 [-0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA(1c) change at 12 months.
  
  
  CONCLUSIONS
  Literacy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.
authors.affiliation: Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. milagros.rosal@umassmed.edu
authors.forename: Milagros C
authors.initials: MC
authors.lastname: Rosal
authors.forename: Ira S
authors.initials: IS
authors.lastname: Ockene
authors.forename: Angela
authors.initials: A
authors.lastname: Restrepo
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: White
authors.forename: Amy
authors.initials: A
authors.lastname: Borg
authors.forename: Barbara
authors.initials: B
authors.lastname: Olendzki
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Scavron
authors.forename: Lucy
authors.initials: L
authors.lastname: Candib
authors.forename: Garry
authors.initials: G
authors.lastname: Welch
authors.forename: George
authors.initials: G
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000378:metabolism / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D057220:Health Literacy; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012648:Self Care / Q000379:methods*; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin